Chpt 2

Question 1

Modifiers

Answer 1

Give additional information
Append to a CPT code to indicate that a service or procedure has been altered for some reason but it does not change the main definition of the code

Question 2

CPT modifiers

Answer 2

Two-digit numeric codes
Appendix A

Question 3

HCPCS Modifiers

Answer 3

Two-digit alphanumeric modifiers

Question 4

Physician services

Answer 4

Place modifiers in 24d of CMS-1500 form following the CPT code

Question 5

Reporting modifiers

Answer 5

Review modifier instructions for the payer you are billing

Question 6

Ranking of Modifiers

Answer 6

Pricing modifiers before statistical and informational modifiers

Question 7

Pricing modifiers

Answer 7

AA, AD, AH, AJ, AS, GM, QB, QK, QU, QX, QY, QZ, SG, TC, UN, UP, UQ, UR, US
22, 26, 50, 51, 52, 53, 54, 55, 56, 62, 66, 73, 74, 78, 80, 82, 99

Question 8

Statistical and informational modifiers

Answer 8

Use in any order except QT, QW, and SF. These can only be used in the first modifier field

Question 9

Modifier 99

Answer 9

Indicates that multiple modifiers are needed for an individual CPT code
Not recognized by all insurance plans

Question 10

Modifiers used for Ambulatory Surgery Center Hospital Outpatient Use
Reported on UB-04/CMS-1450 form

Answer 10

Level I modifiers
22, 27, 33, 50, 52, 58, 59, 73, 74, 76, 77, 78, 79, 91
Level II modifiers
LT, RT, E1, E2, E3, E4, FA, F1-F9, TA, T1-T9, LV, LD, LM, RC, RI, GG, GH, QM, QN, XE, XS, XP, XU

Question 11

Modifier 22

Answer 11

Increased procedural services
Service is greater than usually required for the procedure
Should not be appended to an E/M code
Only truly unusual cases which must have documentation

Question 12

Modifier 23

Answer 12

Unusual anesthesia
A procédure routinely done with no or local anesthesia requires use of general anesthesia

Question 13

Modifier 24

Answer 13

Unrelated E/M service by the same physician during postoperative period
Appended to the E/M code

Question 14

Modifier 25

Answer 14

Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service

Question 15

Modifier 26

Answer 15

Professional component
Should not be appended to codes that do not have a technical component as part of the code definition

Question 16

Modifier 27

Answer 16

Multiple outpatient hospital E/M encounters on the same date
Not to be used for physician reporting of multiple E/M services performed by the same physician on the same day

Question 17

Modifier 32

Answer 17

Mandated services
Required by an insurance company or governmental, legislative or regulatory agency

Question 18

Modifier 33

Answer 18

Preventive service
For separately reported services specifically identified as preventive, the modifier should not be used

Question 19

Modifier 47

Answer 19

Anesthesia by surgeon
Not used when local anesthesia is used
Never appended to the anesthesia code, but to a procedure or service code.

Question 20

Modifier 50

Answer 20

Bilateral procedure
Same operative session
Used only with codes that describe a unilateral procedure
Some people prefer rt and lt modifiers instead of 50

Question 21

Modifier 51

Answer 21

Multiple procedures
Same provider/same operative/procedural session
Used only by providers and is not used by facilities

Question 22

Modifier 52

Answer 22

Reduced services
Partially reduced or eliminated at the physician’s discretion
May require documentation
For outpatient hospital reporting use 73 and 74 not 52

Question 23

Modifier 53

Answer 23

Discontinued procedure
Procedure started but discontinued
Not to report elective cancellation
Indicates that additional services might be provided in the future
For outpatient hospital center use 73 and 74, not 53

Question 24

Modifier 54

Answer 24

Surgical care only
Don’t provide pre-or postoperative care

Question 25

Modifier 55

Answer 25

Postoperative management only

Question 26

Modifier 56

Answer 26

Preoperative management only

Question 27

Modifier 57

Answer 27

Decision for surgery Appended to E/M code when , during the service, the initial decision was made to perform surgery

Question 28

Modifier 58

Answer 28

Staged or related procedure or service by the same physician during the postoperative period During original, second is scheduled (staged procedure) During postoperative period, more extensive care is needed During the postoperative period, therapy is required following the surgical procedure Do not use when 78 is appropriate

Question 29

Modifier 59

Answer 29

Distinct procedural service Procedure independent from other non-E/M services performed on the same day. Procedures that are not typically treated together Use only if another appropriate modifier is not available

Question 30

Subsets of Modifier 59

Answer 30

-X[EPSU] modifiers XE separate encounter XS separate structure XP separate practitioner XU unusual non-overlapping service Do not include modifier 59 if you use one of these

Question 31

Modifier 62

Answer 31

Two surgeons Primary surgeons work together to perform a distinct part of a single reportable procedure Each surgeon reports his own work with modifier 62 Use 80 or 82 if one surgeon assists

Question 32

Modifier 63

Answer 32

Procedure performed on infants less than 4 kgs Only used on codes 20100-69990 unless otherwise designated in the manual

Question 33

Modifier 66

Answer 33

Surgical team Requires several physicians and complex equipment Each provider appends 66 Need documentation

Question 34

Modifier 73

Answer 34

Discontinued outpatient hospital/ambulatory surgery center (ASC) procedure prior to the administration of anesthesia Well-being of patient is threatened Not used for elective cancellation

Question 35

Modifier 74

Answer 35

Discontinued outpatient hospital/Ambulatory surgery center procedure after administration of anesthesia

Question 36

Modifier 76

Answer 36

Repeat procedure or service by same physician The original procedure or service code is the same for both sessions Not appended to an E/M code

Question 37

Modifier 77

Answer 37

Repeat procedure or service by another physician Basic service had to be repeated Same code as original Not appended to an E/M code

Question 38

Modifier 78

Answer 38

Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period Append 78 to the code of the subsequent procedure Documentation may be requested

Question 39

Modifier 79

Answer 39

Unrelated procedure or service by the same physician during the postoperative period Unrelated to the original procedure

Question 40

Modifier 80

Answer 40

Assistant surgeon Assistant physician uses the same code but appends 80 Medicare part b does not cover the services of an assistant surgeon for certain procedures Exemptions on CMS website Payment cannot be collected from the patient if the provider is a participating Medicare provider

Question 41

Modifier 81

Answer 41

Minimum assistant surgeon Assistant required only for a short time or if a 2nd or 3rd assistant surgeon was needed during the procedure

Question 42

Modifier 82

Answer 42

Assistant surgeon when qualified resident surgeon is not available in a teaching facility Must have certification on file

Question 43

Modifier 90

Answer 43

Reference (outside) laboratory

Question 44

Modifier 91

Answer 44

Repeat clinical diagnostic laboratory test Same lab test repeated on the same day to get multiple test results Not for problems with initial collection, confirmation of initial test results, or the availability of an all inclusive code 1st test with normal code, 2nd test with normal code-91 Also not used when a series of tests are run on the same day

Question 45

Modifier 92

Answer 45

Alternative laboratory platform testing Ie. Kit or transportable instrument

Question 46

Modifier 93

Answer 46

Synchronous telemedicine service rendered via telephone other real-time interactive audio-only telecommunications system Must meet the key components as if the service was performed face-to-face

Question 47

Modifier 95

Answer 47

Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system Must be a service listed in appendix P to be used Modifier GT listed for HCPCS services for Medicare but not all payers take this Star icon must appear next to code All components are completed via telemedicine and documented by provider

Question 48

Modifier 96

Answer 48

Habilitative services PT / OT Services not yet learned

Question 49

Modifier 97

Answer 49

Rehabilitative services Occur after a patient was sick, hurt, or disabled

Question 50

Modifier 99

Answer 50

Multiple modifiers Use when more than 2 modifiers are necessary 99 first followed by the next three modifiers with the rest in the narrative box number 19 on CMS-1500

Question 51

HCPCS Level II modifiers

Answer 51

Also provides codes for ambulances and DME Codes may or may not be reimbursed Contact the insurance carrier to see if the code is covered The service being provided needs to be explained further See websites of various carriers and CMS for clarification on usage of these modifiers Comprehensive list in Appendix 2 of HCPCS book

Question 52

HCPCS Modifiers

Answer 52

Multiples of supplies Various body parts when multiple procedures are reported G1-G5: dialysis for unlisted code Additional G modifiers for Medicare J-V: outlines types of modifiers Ambulance origin and destination modifiers Left comes before right, A often before numbers